Unintended pregnancy during the first year after breast cancer diagnosis

Abstract

Objectives: Young women experience high levels of anxiety and distress during cancer diagnosis and therapy, and it can be devastating to become pregnant in this vulnerable state. Pregnancy during cancer treatment is strongly discouraged, as radiotherapy and chemotherapy administered during the first trimester of pregnancy result in increased congenital malformations.

Methods: In this study, we analysed an unselected, consecutive cohort of young breast cancer (BC) patients with regard to unintended pregnancy during the first year after BC diagnosis. We analysed all patients who were ≤40 years of age at initial BC diagnosis (n = 100, mean age at diagnosis: 35.9 years), according to data from the Basel Breast Cancer Database. The frequency of unintended pregnancy was assessed, and particular attention was given to patients’ obstetric and reproductive history.

Results: Forty-two percent of the cohort (mean age 36.5 years) were identified as not at risk of unintended pregnancy during the first year after BC diagnosis. However, 58% of the cohort (mean age 35.6 years) were using an ineffective contraceptive method and thus were at risk of unintended pregnancy. The rate of unintended pregnancy was 3.5% in this group (two patients). Oncologists should be aware that the use of reliable contraception should be discussed before starting, and also during, adjuvant therapy.

Conclusions: Oncologists should consider actively referring young BC patients to a gynaecologist to ensure proper contraceptive counselling.

Chinese abstract

目的：用只含有孕激素的避孕药可能会引起出血模式的变化, 这是这些方法不能继续应用的一个常见原因。联合应用一些抗逆转录病毒疗法（ART）的制剂可改变释放依托孕烯（ENG）的避孕植入剂的生物利用度, 进而影响出血模式。评估HIV阳性应用ENG植入剂联合两种常见的抗逆转录病毒制剂患者的出血模式。

方法：包括45名HIV阳性希望应用ENG避孕植入剂的的女性患者：15名女性接受齐多夫定/拉米夫定(AZT/3TC) 及洛匹那韦/利托那韦（LPV/R）治疗≥3个月（LPV/R的ART组）, 15名接受AZT/3TC及依法韦仑（EFV）治疗≥3个月（EFV的ART组）, 还有15名未接受ART（非ART组）。在植入剂植入后3个月和6个月用标准的出血日历评估出血模式。 结果：闭经和罕见的出血率在LPV/R-ART组（分别为50%和36%）高于其他组（非ART组分别为36%和29%；EFV的ART组别为7%和14.5%, P = 0.01）。EFV的ART组比其他组规律出血（71.5%）更常见, （LPV/R-ART组, 7%；非ART组, 21%；P = 0.01）。频率和出血时间延长在三组中的比例相似（P > 0.05）。

结论：ENG避孕植入剂联合EFV或LPV/R-ART用药影响植入剂预期的出血模式, 虽然不利的出血（频繁和时间长）与评估的药物无关。

Keywords:

• Breast cancer
• contraception
• unintended pregnancy

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.